Policy Updates

Federal Health Policy Update for April 3

The following is the latest health policy news from the federal government for March 27 to April 3. Some of the language used below is taken directly from government documents. Proposed and Final CMS Medicare Regulations Proposed FY 2027 Medicare Inpatient Rehabilitation Facilities Payment Rule CMS has published a proposed rule updating Medicare payment policies and rates for inpatient rehabilitation facilities (IRF) under its IRF prospective payment system and updating the IRF quality reporting program for FY 2027. CMS proposes updating FY 2027 IRF rates by 2.4 percent based on a market basket update of 3.2 percent less a proposed [...]

joe2026-04-03T13:22:10-04:00April 3, 2026|Accountable Care Organization, ACO, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Congress, Medicaid, Medicare regulations, Medicare reimbursement policy|

Hospitals Sue Over Medicare DSH Payments

More than 100 hospitals have sued the Department of Health and Human Services, arguing that the manner in which the Centers for Medicare & Medicaid Services calculates their Medicare disproportionate share payments shortchanges hospitals that care for especially large numbers of low-income patients – the very hospitals Medicare DSH payments were created to help. According to the hospitals, CMS’s Medicare DSH payment methodology undercounts the number of low-income patients hospitals serve, thereby reducing the Medicare DSH payments yielded under the Medicare DSH payment calculation formula adopted in 2023. Learn more about how the suing hospitals believe CMS is undercounting their [...]

joe2026-04-01T12:33:31-04:00April 3, 2026|hospitals, Medicare disproportionate share, Medicare DSH|

No More Hospital Jello?

The days of enjoying a heaping bowl of jello while stuck in a hospital bed may soon become a thing of the past. In a new directive to hospitals, the Centers for Medicare & Medicaid Services has told hospitals that they need to do a better job of meeting their patients’ nutrition needs and “…to align food service with the 2025–2030 Dietary Guidelines for Americans, which prioritize whole, nutrient-dense foods and adequate protein while limiting ultra-processed foods and added sugars.” The CMS memo to hospitals offers the following guidelines: Limiting ultra-processed food options for patients. Elimination of sugar-sweetened beverages unless [...]

joe2026-03-31T15:19:12-04:00April 2, 2026|Centers for Medicare & Medicaid Services, hospitals|

Medicare Increases Emphasis on Behavioral Health

Medicare policy is evolving to encourage providers to take a more active role in addressing the behavioral health needs of their patients. In traditional Medicare, new payment codes encourage practitioners to spend more time identifying and helping patients with their behavioral health challenges. Meanwhile, CMS and its Center for Medicare and Medicaid Innovation have introduced several new care and payment models that place a greater emphasis on beneficiaries’ behavioral health needs. Among them: The LEAD (Long-Term Enhanced ACO Design) Model, which seeks to include more behavioral health providers and encourages greater integration of behavioral health care. The ACCESS (Advancing Chronic [...]

joe2026-03-31T17:02:07-04:00April 1, 2026|Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Medicare|

Hospitals Had a Rough January

Hospitals’ financial performance in January of 2026 suffered in comparison to that in January of 2025, according to a recent report. The report found that: Discharges fell two percent. Emergency department visits were off five percent. Average length of stay declined three percent. Expenses rose five percent. Labor costs increased five percent. Bad debt and charity care rose eight percent. Learn more about how the new year brought financial challenges to hospitals from the Healthcare Dive article Hospitals’ financial performance off to a shaky start in 2026: report.

joe2026-03-25T10:29:31-04:00March 27, 2026|hospitals|

Federal Health Policy Update for March 26

The following is the latest health policy news from the federal government for March 20-26. Some of the language used below is taken directly from government documents. Congress Republican leadership is exploring a reconciliation bill as a potential vehicle to fund Immigrations and Customs Enforcement (ICE) and pass the Safeguard American Voter Eligibility Act (SAVE) voting rights act. If pursued, this approach could increase the likelihood of additional health care cuts, including expanding site-neutral payment policies in both Medicare and Medicaid. It is not clear whether there will be sufficient support in either chamber for Republicans to pursue a party-line [...]

joe2026-03-26T15:09:34-04:00March 26, 2026|Alternative payment models, Center for Medicare and Medicaid Innovation, CMMI, Congress, hospitals, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicare, Medicare regulations, Medicare reimbursement policy|

FTC Creates Health Care Task Force

A new group will join the fight to protect Americans from their country’s health care system. The Federal Trade Commission has announced the creation of a health care task force “…that will engage in a coordinated, integrated approach to healthcare enforcement and advocacy to protect American patients, healthcare workers, and taxpayers.” According to the FTC, the task force will: Lead targeted enforcement and advocacy initiatives focused on key priorities; Devise coordinated agencywide strategies on investigations; Take a proactive and strategic approach to identifying amicus and statement of interest opportunities; and Identify emerging issues and new priority areas for enforcement and [...]

joe2026-03-24T14:29:41-04:00March 26, 2026|Uncategorized|

CMS Takes an Axe to the Fax

The days of sending health care claims forms and claims-related documents by fax and regular U.S. mail are fast drawing to a close. Last week the Centers for Medicare & Medicaid Services announced that it will adopt a new regulation – “The Administrative Simplification; Adoption of Standards for Health Care Claims Attachments Transactions and Electronic Signatures Final Rule” – that will establish HIPAA-compliant standards for sharing health care claims attachments, enabling the secure electronic exchange of health care claims-related supporting clinical documentation and attachments such as medical records, x-rays and imaging, clinical notes, telemedicine visit documentation, and laboratory results. The [...]

joe2026-03-24T13:44:33-04:00March 25, 2026|Uncategorized|

No Surprises Act Activity in 2025

A new Health Affairs report offers a preliminary look at No Surprises Act Independent Dispute Resolution activity for 2025. Among its findings: Providers and facilities initiated 99.9 percent of the disagreements submitted to the IDR process. Four provider groups or representatives of provider groups initiated more than half of those cases. Providers prevailed in 88 percent of the cases. Health plans challenged 40 percent of the cases submitted to the IDR process as ineligible for adjudication under that process. The IDRs upheld their challenges only 17 percent of the time. Health plans are starting to sue those submitting large numbers [...]

joe2026-03-24T16:48:35-04:00March 25, 2026|Uncategorized|

Looking Ahead to New Health Plan Price Transparency Requirements

If the new health plan price transparency requirements proposed by the Centers for Medicare & Medicaid Services are finalized later this year and implemented a year later, as anticipated, they will usher in significant changes in available data for use by consumers, providers, and businesses that collect, analyze, package, and sell such data. The anticipated changes in transparency requirements could include: Specific identification of rate changes from the most recently published rate. Reduced file sizes that eliminate some currently required data and a requirement that health plans post a single in-network file for each provider network instead of a file [...]

joe2026-03-19T17:26:12-04:00March 24, 2026|Uncategorized|